198602596-12-1-2025-28-AS-DSIS-DP6TRA-20251208135714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602596
Report Date: 12/01/2025
Date Signed: 12/01/2025 12:44:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251120114655

FACILITY NAME:	JASWILL BROOKMILL		FACILITY NUMBER:	198602596
ADMINISTRATOR:	CRUZ, JASFER		FACILITY TYPE:	735
ADDRESS:	7822 BROOKMILL RD		TELEPHONE:	(562) 381-0242
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	4	CENSUS: 4	DATE:	12/01/2025
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Amiel Belen - Caregiver		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee did not comply with requirements for retaining a resident with a restricted health condition.
Licensee did not ensure staff were adequately trained to provide care to residents.
Licensee did not follow infection control practices.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Caregiver Amiel Belen and explained the purpose of today's visit. LPA also spoke with Admisitrator Jasfer to explain findings.

The investigation consisted of the following:
On 11/25/25 LPA obtained copies of the following from Client #1's (C1's) file: Discharge Paperwork from Hospital, Individual Program Plan (IPP), Nursing Notes, Individual Restricted Health Condition Care Plan, Health Care Plan for Indwelling Foley Catheter, and Physician Report. LPA conducted interviews with 6 Staff (S1-S6) and 2 Clients (C2-C3).
During todays vist 12/1/25 LPA delivered findings on the reported allegations.

(Continued on LIC-9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251120114655

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASWILL BROOKMILL	FACILITY NUMBER: 198602596
	VISIT DATE: 12/01/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Licensee did not comply with requirements for retaining a resident with a restricted health condition.

It is alleged that C1 has a restricted health condition and facility does not have proper care plan for C1’s new condition. LPA obtained copies of the South Central Los Angeles Regional Center Individual Restricted Health Condition Care plan and additional Health Care Plan for C1 and the plan explained that C1 has a Home Health Nurse that will visit client 2-3x a week for catheter care and the facility has a staff that is a registered nurse that will provide the care (if needed) on the other days. Per hospital discharge paperwork C1 was discharged with a Urethral Structure (catheter) on 11/10/25 and was provided with Home Health Services to provide the proper care for C1. LPA interviewed 6 staff and each denied the allegation and stated that although C1 does have a restricted health condition, only the Home Health Nurse or Facility Nurse provide assistance/care for C1’s restricted condition. Interview with S5 revealed that they are a registered nurse and there are other staff at sister facilities that also hold a RN Certificate that are properly trained and qualified to provide the needed care for C1’s condition, additionally S5 stated they visit with C1 about 3 days weekly and/or as needed. LPA reviewed S5’s RN Certificate which is valid with an expiration date of 10/21/26.
Allegation: Licensee did not ensure staff were adequately trained to provide care to residents.
It is alleged that staff are not properly trained to assist with catheter care or hoyer lift. LPA interviewed 6 staff and each denied the allegation, 5 out of 6 staff stated they are not trained to assist with C1s catheter care but there is a nurse that visits almost daily to provide assistance with the catheter. 3 of the 6 staff interviewed stated they are new and have not been trained on using the hoyer lift but have been shadowing and assist a staff that is fully trained if hoyer lift use is needed. S1 stated that the hoyer lift is not something they use daily or regularly and only need to use when a client is too weak to assist with transfers. LPA reviewed the Hoyer Lift in-service training and it showed that on 7/12/25, 7/15/25, 8/28/25 and 9/5/25 there were training's held that covered Safe transfers with a Manual Hoyer Lift, there was a total of 13 staff that have completed the training. LPA interviewed 3 clients and 3 out of 3 clients denied the allegation and stated that they feel staff are properly trained to provide the care they need.

(Continued on LIC-9099C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251120114655

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JASWILL BROOKMILL	FACILITY NUMBER: 198602596
	VISIT DATE: 12/01/2025

NARRATIVE

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Allegation: Licensee did not follow infection control practices.
It is alleged that a client tested positive for Covid, facility ran out of masks and it took a week to have supplies replenished. LPA inspected supplies and there was a sufficient supply of masks and gloves. LPA interviewed 6 staff and each denied the allegation and stated that they have never been out of supplies and do not recall being out of masks during the time that C1 was covid positive. Staff also stated that C1 was isolated in efforts to keep the virus from spreading to other clients and staff, and all infection control practices were followed. LPA interviewed 3 Clients and 2 out of 3 Clients denied the allegation and stated that staff were using masks, gloves, cleaning and disinfecting regularly when there was a covid positive client and that C1 was isolated during that time also.

Based on statements and interviews conducted with staff/clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025

LIC9099 (FAS) - (06/04)

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